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Insurance - Dependable Graham 2023-06-12r ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) `.....� 6/12/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME Kelli Orleck Venture Pacific Insurance Services — -- – FAX 111 Corporate Drive #200 a/j C�No Ext : 949-297-4900 CzNo� 949-297-4911 Ladera Ranch CA 92694 E-MAIL ADDRESS: korleck�a vpisrisk.com PRO - POLICY X ECT LOC INSURERS) AFFORDING COVERAGE,/"NAIC # License#:_OD10299 INSURERA_ Vallev Forge Insurance CO>pany 11'20508 INSURED DEPEGRA-01 INSURER B: The Continental Insurance Company 35289 Dependable Graham Air Conditioning, Inc. — _-- - -- - -- ---- -- 2952 Century Place INSURER c Costa Mesa CA 92626 INSURER D: AUTOS ONLY AUTOS ONLY INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 1618252887 REVISION NUMBER_ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. rn INSR TYPE OF INSURANCE 'ADDL SUER - -- __-_ __ - POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 6075714593 1/1/2023 1/1/2024 EACH OCCURRENCE 51,000,000 X 'OCCUR DAMAGE TO RENTEDPREMISES_ CLAIMS -MADE Ea occurrence S 500,000 X 10.000 MED EXP (Any one person) S15,000 PERSONAL & ADV INJURY S1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 PRO - POLICY X ECT LOC PRODUCTS - COMP/OP AGG S 2,000,000 OTHER: S B AUTOMOBILE LIABILITY Y Y '6075714609 1/1/2023 1/1/2024 COMBINED SINGLE LIMIT S11,000,000 __(Ea accident) --- X ANY AUTO- BODILY INJURY (Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS _ _ BODILY INJURY (Per accident), $ X HIRED X NON -OWNED _ _ PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY �Pgr accident! _ B X UMBRELLA LIAR X OCCUR Y Y 6075714612 1/1/2023 1/1/2024 EACH OCCURRENCE S5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED , X RETENTIONS 1 n nnnS WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITYY / N STATUTE _ _ER ANYPROPRIETOR/PARTNER/EXECUTIVEE.L. EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? N / A -------------- — (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE S If yes, describe under _ DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S A Rented/Leased Equip. 6075714593 1/1/2023 1/1/2024 Limit/Ded. per item $25,000/$500 ded Limit - max $50,000 Builder's Risk/Install/ Floater Limit/Ded. per loc $50,000/$1,000 ded DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Costa Mesa Sanitary District, their elected and appointed officials, agents, officers, volunteers and employees is named as additional insured as required by written contract but only insofar as the insureds operations. Coverage is primary and non-contributory. 30 Days Notice of Cancellation for any reason, 10 Days Notice of Cancellation for non-payment of Premium. CERTIFICATE HOLDER CANCELLATION ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE rn THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa Sanitary District 290 Paularin0 Ave. AUTHORIZED REPRESENTATIVE Costa Mesa CA 92626 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CNA63359XX CNA Dependable Graham Air Conditioning, Inc (Ed. 04/12) 6075714609 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS EXTENDED COVERAGE ENDORSEMENT - BUSINESS AUTO PLUS - ff�= 111211111211 �=! BUSINESS AUTO COVERAGE FORM 1. LIABILITY COVERAGE A. Who Is An Insured The following is added to Section 11, Paragraph A.I., Who Is An Insured: 1. a. Any incorporated entity of which the Named Insured owns a majority of the voting stock on the date of inception of this Coverage Form; provided that, b. The insurance afforded by this provision A.I. does not apply to any such entity that is an "insured" under any other liability "policy" providing "auto" coverage. 2. Any organization you newly acquire or form, Other than a limited liability company, partnership or joint venture, and over which you maintain majority ownership interest. The insurance afforded by this provision A.2.: a. Is effective on the acquisition or formation date, and is afforded only until the end of the policy period of this Coverage Form, or the next anniversary of its inception date, whichever is earlier. it) b. Does not apply to: (1) "Bodily injury" or "property damage" cc caused by an "accident" that occurred before you acquired or formed the organization; or N C, C") C, (2) Any such organization that is an "insured" under any other liability "policy" providing "auto" coverage, 3. Any person or organization that you are required by a written contract to name as an additional insured is an "insured" but only with respect to their legal liability for acts or omissions of a person, who qualifies as an "insured" under Section 11 - Who Is An Insured and for whom Liability Coverage is afforded under this policy. If required by written contract, this insurance will be primary and non-contributory to insurance on which the additional insured is a Named Insured. 4. An "employee" of yours is an "insured" whilt; operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. "Policy," as used in this provision A. Who Is An Insured, includes those policies that were in force *n the inception date of this Coverage Form but: 0 Section 11, Paragraphs A.2. (2) and A.2. (4) are revised as follows: 1. In a.(2), the limit for the cost of bail bonds is changed from $2,000 to $5,000; and 2. In a.(4), the limit for the loss of earnings is changed from $250 to $500 a, day. C. Fellow Employee Section 11, Paragraph B.5 does not apply. Such coverage as is afforded by this provision C. is excess over any other collectible insurance. 11. PHYSICAL DAMAGE COVERAGE A. Glass Breakage - Hitting A Bird Or Animal - Failing Objects Or Missiles The following is added to Section 111111, Paragraph A.3.-. With respect to any covered "auto," any deductible shown in the Declarations will not apply to glass breakage if such glass is repaired, in a manner acceptable to us, rather than replaced. B. Transportation Expenses Section III, Paragraph AA.a. is revised, with respect to transportation expense incurred by you, to provide: a. $60 per day, in lieu of $20; subject b. $1,800 maximum, in lieu of $600. 1 Section III, Paragraph AA.b. is revised, with respect to loss of use expenses incurred by you, to provide: a. $1,000 maximum, in lieu of $600. CNA63359XX Copyright. CNA Corporation, 2000, Page 1 of 3 (Ed. 04/12) Includes copyrighted material of the Insurance Services Office used with its permission. D. Hired "Autos" The following is added to Section 111. Paragraph A.. 5. Hired "Autos" If Physical Damage coverage is provided under this policy, and such coverage does not extend to Hired Autos, then Physical Damage coverage is extended to: a. Any covered "auto" you lease, hire, rent or borrow without a driver; and b. Any covered "auto" hired or rented by your "employee" without a driver, under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. c. The most we will pay for any one "accident" or "loss" is the actual cash value, cost of repair, cost of replacement or $75,000, whichever is less, minus a $500 deductible for each covered auto. No deductible applies to "loss" caused by fire or lightning. d. The physical damage coverage as is provided by this provision is equal to the physical damage coverage(s) provided on your owned "autos." e. Such physical damage coverage for hired "autos" will: (1) Include loss of use, provided it is the consequence of an "accident" for which the Named Insured is legally liable, and as a result of which a monetary loss is sustained by the leasing or rental concern. (2) Such coverage as is provided by this provision will be subject to a limit of $750 per "accident." E. Airbag Coverage The following is added to Section 111, Paragraph B.3.. The accidental discharge of an airbag shall not be considered mechanical breakdown. F. Electronic Equipment Section III, Paragraphs B.4.c and B.4.d. are deleted and replaced by the following: c. Physical Damage Coverage on a covered "auto" also applies to "loss" to any permanently installed electronic equipment including its antennas and other accessories. CNA63359XX (Ed. 04/12) d. A $100 per occurrence deductible applies to the coverage provided by this provision. G. Diminution In Value The following is added to Section 111, Paragraph B.6.: Subject to the following, the "diminution in value" exclusion does not apply to: a. Any covered "auto" of the private passenger type you lease, hire, rent or borrow, without a driver for a period of 30 days or less, while performing duties related to the conduct of your business; and b. Any covered "auto" of the private passenger type hired or rented by your "employee" without a driver for a period of 30 days or less, under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. c. Such coverage as is provided by this provision is limited to a "diminution in value" loss arising directly out of accidental damage and not as a result of the failure to make repairs; faulty or incomplete maintenance or repairs; or the installation of substandard parts. d. The most we will pay for "loss" to a covered "auto" in any one accident is the lesser of: (1) $5,000; or (2) 20% of the "auto's" actual cash value (ACV). III. Drive Other Car Coverage — Executive Officers The following is added to Sections 11 and 111: 1. Any "auto" you don't own, hire or borrow is a covered "auto" for Liability Coverage while being used by, and for Physical Damage Coverage while in the care, custody or control of, any of your "executive officers," except: a. An "auto" owned by that "executive officer" or a member of that person's household; or b. An "auto" used by that "executive officer" while working in a business of selling, servicing, repairing or parking "autos." Such Liability and/or Physical Damage Coverage as is afforded by this provision. (1) Equal to the greatest of those coverages afforded any covered "auto"; and CNA63359XX Copyright, CNA Corporation, 2000. Page 2 of 3 (Ed. 04/12) Includes copyrighted material of the Insurance Services Office used with its permission. (2) Excess over any other collectible insurance. K. For purposes of this provision, "executive office�; means a person holding any of the officer positions created by your charter, constitution, by- laws or any other similar governing document, and, while a resident of the same household, includes that person's spouse. Such "executive officers" are "insureds" while using a covered "auto" described in this provision. A. Duties In The Event Of Accident, Claim, Suit Or Loss The following is added to Section IV, Paragraph A.2.a.: (4) Your "employees" may know of an "accident" or "loss." This will not mean that you have such knowledge, unless such "accident" or "loss" is known to you or if you are not an individual, to any of your executive officers or partners or your insurance manager. The following is added to Section IV, Paragraph A.2 -b.: (6) Your "employees" may know of documents received concerning a claim or "suit." This will not mean that you have such knowledge, unless receipt of such documents is known to you or if you are not an individual, to any of your executive officers or partners or your insurance manager. B. Transfer Of Rights Of Recovery Against Others To Us The following is added to Section IV, Paragraph A.5. Transfer Of Rights Of Recovery Against Others To Us: We waive any right of recovery we may have, because of payments we make for injury or damage, against any person or organization for whom or which you are required by written contract or agreement to obtain this waiver from us. This injury or damage must arise out of your ,?,ctivities under a contract with that person or #rganization. You must agree to that requirement prior to an "accident" or "loss." C. Concealment, Misrepresentation or Fraud The following is added to Section IV, Paragraph B.2.: The following is added to Section IV, Paragrapl- B.5.: Regardless of the provisions of Paragraphs 5.a. and 5.d. above, the coverage provided by this policy shall be on a primary non-contributory basis, This provision is applicable only when required by a written contract, That written contract must have been entered into prior to "Accident" or Section IV, Paragraph B. a). is revised to provide: a. 45 days of coverage in lieu of 30 days. MIKUNH =* Section V. Paragraph C. is deleted and replaced by the following, CNA63359XX Copyright, CNA Corporation, 2000, (Ed. 04/12) Includes copyrighted material of the Insurance Services Office used with its permission, CNA CNA PARAMOUNT Primary and Noncontributory - Other Insurance Condition Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART It is understood and agreed that the condition entitled Other Insurance is amended to add the following: Primary And Noncontributory Insurance Notwithstanding anything to the contrary, this insurance is primary to and will not seek contribution from any other insurance available to an additional insured under this policy provided that: a. the additional insured is a named insured under such other insurance; and b. the Named Insured has agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA74987XX (1-15) Policy No: 6075714593 Page 1 of 1 Endorsement No: 14 VALLEY FORGE INSURANCE COMPANY Effective Date: 01/01/2023 Insured Name: DEPENDABLE GRAHAM AIR - CONDITIONING, INC Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. M M M O LOLO0 M O O O O N O O O CNA CNA PARAMOUNT Waiver of Transfer of Rights of Recovery Against Others to the Insurer Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: ANY PERSON OR ORGANIZATION WHOM THE NAMED INSURED HAS AGREED IN WRITING IN A CONTRACT OR AGREEMENT TO WAIVE SUCH RIGHTS OF RECOVERY, BUT ONLY IF SUCH CONTRACT OR AGREEMENT: 1. IS IN EFFECT OR BECOMES EFFECTIVE DURING THE TERM OF THIS COVERAGE PART;AND 2. WAS EXECUTED PRIOR TO THE BODILY INJURY,PROPERTY DAMAGE OR PERSONAL AND ADVERTISING INJURY GIVING RISE TO THE CLAIM. (Information required to complete this Schedule, if not shown above, will be shown in the Declarations.) Under COMMERCIAL GENERAL LIABILITY CONDITIONS, it is understood and agreed that the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended by the addition of the following: With respect to the person or organization shown in the Schedule above, the Insurer waives any right of recovery the Insurer may have against such person or organization because of payments the Insurer makes for injury or damage arising out of the Named Insured's ongoing operations or your work included in the products -completed operations hazard. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA75008XX (10-16) Policy No: 6075714593 Page 1 of 1 Endorsement No: 15 VALLEY FORGE INSURANCE COMPANY Effective. Date: 01/01/2023 Insured Name: DEPENDABLE GRAHAM AIR - CONDITIONING, INC Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office. Inc., with its permission. co M LO Ln 0 M 0 O O N O O 0 CNA CNA PARAMOUNT Blanket Additional Insured -Owners, Lessees or Contractors -with Products -Completed Operations Coverage Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I. WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury caused in whole or in part by your acts or omissions, or the acts or omissions of those acting on your behalf: A. in the performance of your ongoing operations subject to such written contract; or B. in the performance of your work subject to such written contract, but only with respect to bodily injury or property damage included in the products -completed operations hazard, and only if: 1. the written contract requires you to provide the additional insured such coverage; and 2. this coverage part provides such coverage. 11. But if the written contract requires: A. additional insured coverage under the 11-85 edition, 10-93 edition, or 10-01 edition of CG2010, or under the 10- 01 edition of CG2037; or B. additional insured coverage with "arising out of language; or C. additional insured coverage to the greatest extent permissible by law; then paragraph I. above is deleted in its entirety and replaced by the following: WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of your work that is subject to such written contract. III. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: A. coverage broader than required by the written contract; or B. a higher limit of insurance than required by the written contract. IV. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of.- A. f: A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: 1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. supervisory, inspection, architectural or engineering activities; or B. any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part. V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance is amended to add the following, which supersedes any provision to the contrary in this Condition or elsewhere in this coverage part: CNA75079XX (10-16) Policy No: 6075714593 Page 1 of 2 Endorsement No: 9 VALLEY FORGE INSURANCE COMPANY Effective Date: 01/01/2023 Insured Name: DEPENDABLE GRAHAM AIR - CONDITIONING, INC Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA CNA PARAMOUNT Blanket Additional Insured -Owners, Lessees or Contractors -with Products -Completed Operations Coverage Endorsement Primary and Noncontributory Insurance With respect to other insurance available to the additional insured under which the additional insured is a named insured, this insurance is primary to and will not seek contribution from such other insurance, provided that a written contract requires the insurance provided by this policy to be: 1. primary and non-contributing with other insurance available to the additional insured; or 2. primary and to not seek contribution from any other insurance available to the additional insured. But except as specified above, this insurance will be excess of all other insurance available to the additional insured. VI. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following.- Any ollowing:Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim; and 3. make available any other insurance, and tender the defense and indemnity of any claim to any other insurer or self -insurer, whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph 3. does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VII. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires you to make a person or organization an additional insured on this coverage part, provided the contract or agreement: A. is currently in effect or becomes effective during the term of this policy; and B. was executed prior to. - 1. o: 1. the bodily injury or property damage; or 2. the offense that caused the personal and advertising injury; for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA75079XX (10-16) Policy No: 6075714593 Page 2 of 2 Endorsement No: 9 VALLEY FORGE INSURANCE COMPANY Effective Date: 01/01/2023 Insured Name: DEPENDABLE GRAHAM AIR - CONDITIONING, INC Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. OCAIRCO-01 LAUREN ,acorr,r�► CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) 6//12/212/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: _ __ _ Goodman Insurance Services PHONE FAX 27042 Towne Centre Drive, Suite 120 (A/C, No Ext): (949) 769-3100 (A/c No)_(949) 769 3930 Foothill Ranch, CA 92610 a DRESS: INSURED Dependable Graham Air Conditioning, Inc. 2952 Century Place Costa Mesa, CA 92626 INSURER B INSURER C: INSURER D INSURER F : JRER(SJAFFORDING COVERAGE _ NA American Indemnitv Companv '39152 rnv�Rer_Gc r G0TICIr'ATC All IRROCO- oc11101nuI Kl RAMCAM. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE E BEEN REDUCED BY PAID CLAIMS. ---_-__----__-.. _------_. _ _— _- __ _ _ ____-. __- - _ _ —_ - -_-- ILT R TYPE OF INSURANCE ADDL;SUBR POLICY NUMBER POLICY EFF POLICY EXP LTR INSD i WVD MM/DD/YYYY) MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (An ,_oneperson) $ PERSONAL & ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S -- POLICY PRO-JECT LOC - - PRODUCTS - COMP/OP AGG S OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT �Ea_a_ccident) - _ S ANY AUTO BODILY INJURY (Per S OWNED SCHEDULED _. _. _. - AUTOS ONLY AUTOS BODILY INJURY (Per accident): S HIRED NON -OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLYtPer accident) _ _ S !S UMBRELLA UAB !OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS -MADE AGGREGATE S DED RETENTIONS S A WORKERS COMPENSATION XPER OTH- AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARLUDEDXECUTIVE SAMTWC0072801 7/1/2022 7/1/2023 '___STATUTE_ '___ER 1000 ,000 ELEACH ACCIDENT S OFFICER/MEMBER EXCLUDED? Y N /A (Mandatory in NH) 1,000,000 E L. DISEASE - EA EMPLOYEE S If yes, describe under --- — — — --- --- 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Proof of Insurance Certificate holders continued: Costa Mesa Sanitary District, their elected and appointed officials, agents, officers, volunteers, and employees rGRTICIreT;: unl 11=0 r'AKIrCI I ATWIM AGORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary District ry 290 Paularino Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Costa Mesa, CA 92626 AUTHORIZED REPRESENTATIVE AGORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD